AMH + Fertility: how important is it and what implications does it ACTUALLY have?
AMH (Anti-Müllerian Hormone) is produced by the small follicles in the ovaries. It gives an indication of egg quantity, not quality, and it does not predict the ability to conceive naturally. A low level means there may be fewer developing follicles—not that the eggs cannot function or that pregnancy isn’t possible. HOWEVER it shouldn’t be completely ignored and context is absolutely key. AMH is dynamic. It is influenced by metabolic, inflammatory, hormonal and environmental factors—not just age or genetics.
Why Other Aspects of Health Can Influence AMH
Inflammation and Immune Load
Chronic inflammation (from infection, gut issues, autoimmunity, lifestyle stressors) can affect the ovarian environment.
How this impacts AMH:
Inflammation increases oxidative stress around follicles
This can reduce follicular survival
The ovary becomes less efficient at producing AMH
Reactivated viral infections, gut dysbiosis, chronic stress, poor sleep can all subtly reduce ovarian hormone output.
Metabolic Health & Blood Sugar Regulation
The ovary is highly sensitive to insulin and glucose levels.
Impact on AMH and fertility:
High insulin can lower AMH production
Dysregulated glucose increases oxidative stress in ovarian tissue
Mitochondria in the eggs become less efficient
Even mild blood sugar imbalance or prediabetes can reduce AMH and egg competence, but improving metabolic health can help stabilise reproductive hormones.
Thyroid Function & Adrenal Stress Response
Thyroid and adrenal health strongly influence ovarian reserves and overall fertility.
Effects include:
Low thyroid function slows ovarian signalling
High cortisol reduces gonadotropin signalling and follicle maturation
Stress hormones can suppress AMH temporarily
This is why stress recovery, sleep, and nervous system regulation can support AMH and cycle quality.
Nutrient Status & Mitochondrial Energy in the Ovary
The ovary requires extremely high levels of micronutrients, antioxidants, and energy.
Nutrients linked with follicle development and AMH support include:
Vitamin D
B vitamins (esp. B6, B12, folate)
Omega-3s
CoQ10
Selenium, zinc, iodine
Antioxidant-rich polyphenols
Low nutrient status reduces the ovary’s ability to maintain healthy follicles → lower AMH output.
Environmental & Lifestyle Factors
Exposure to chemicals, lifestyle strain, and overall toxic load can influence ovarian reserve.
These factors can impact AMH:
They don’t just influence AMH values—they impact how the follicles develop throughout a 90-day window.
Endocrine disruptors (plastics, fragrances, pesticides)
Smoking or high alcohol intake
Shift-work or poor sleep
They don’t just influence AMH values—they impact how the follicles develop throughout a 90-day window.
Focusing on:
✨ gut health
✨ metabolic balance
✨ stress & sleep
✨ nutrient optimisation
✨ reduced inflammation
✨ improved mitochondrial health
…can all help support AMH stability, egg quality, and overall fertility outcomes.
How Inflammatory Diseases Like Endometriosis Impact AMH
Endometriosis is a chronic inflammatory condition, and AMH is highly sensitive to inflammation within and around the ovaries.
AMH reflects how many healthy, functioning follicles are present—not just how many eggs exist in total. In endometriosis, the inflammatory environment can reduce AMH output even when eggs are still present.
Endometriosis creates ongoing inflammation around the ovaries. This inflammation can reduce how well the ovarian follicles function and how much AMH they produce. So a low AMH doesn’t always mean you’ve run out of eggs—it can reflect how stressed the ovarian environment is. Improving inflammation, immune balance, and metabolic health can help support ovarian function, even if AMH doesn’t dramatically increase.
Chronic Inflammation Suppresses AMH Production
In Endometriosis:
Pro-inflammatory cytokines (e.g. TNF-α, IL-6, IL-1β) are elevated
These inflammatory signals impair granulosa cell function
Granulosa cells are responsible for AMH production
Result: Reduced AMH secretion, even without true egg loss.
This is why AMH can sometimes appear lower than expected for age in women with endometriosis.
Oxidative Stress Damages the Follicular Environment
Endometriosis creates high levels of oxidative stress in the pelvis and ovaries.
This leads to:
Mitochondrial dysfunction in developing follicles
Increased follicle atresia (early follicle loss)
Reduced follicle survival over time
Over months or years, this can contribute to a real decline in ovarian reserve, not just a functional suppression.
Ovarian Endometriomas Have a Direct Effect on AMH
When endometriosis affects the ovary itself (endometriomas):
Healthy ovarian tissue is compressed and inflamed
Blood flow and oxygen delivery are reduced
Follicle development is disrupted
Even without surgery, endometriomas are associated with lower AMH levels. Surgical removal can further reduce AMH due to unavoidable loss of ovarian tissue—this is a major counselling point in fertility care and should be well thought through.
Immune Dysregulation Alters Ovarian Signalling
Endometriosis is associated with:
Altered immune tolerance
Autoimmune-like features
Increased macrophage activity around the ovary
This disrupts normal ovarian signalling pathways involved in follicle recruitment and AMH production.
In other words, the ovary receives “stress signals” that reduce reproductive hormone output.
Hormonal Disruption Amplifies the Effect
Inflammation in endometriosis also impacts:
Oestrogen metabolism (local oestrogen excess)
Progesterone resistance
Hypothalamic-pituitary-ovarian (HPO) signalling
This hormonal imbalance can further suppress AMH expression and impair follicle development—independent of egg number.
KEY TAKEAWAYS
AMH can be functionally suppressed by inflammation.
Endometriosis affects AMH even before surgery
Reducing inflammation may stabilise ovarian reserve over time
Supporting mitochondrial and immune health is critical
